follicular dysplasia
Introduction
Introduction to follicular dysplasia Follicular dysplasia refers to the late follicular growth, follicular growth can not reach the size of mature follicles, and the function is poor, the secretion of estrogen is insufficient, the clinical examination of the cervical score can not reach the high value (> 10 points). This group of monitoring found that this situation is very common among infertile women, the incidence rate can reach 27.0%, and repeated in the same patient in different cycles, the repetition rate reached 63.8%, even in its non-FM cycle is different The degree of abnormality. This finding suggests that FM may be an important cause of infertility. Ritchie also reported that infertility caused by abnormal follicular dysplasia and ovulation disorders accounted for about 15% to 25%, similar to this group of data. When the follicles mature, the function will be sound, and the discharged eggs will mature and healthy. If the follicles are dysplastic, the ovulation cannot be performed normally or the quality of the discharged eggs is not good, it will affect normal fertility. basic knowledge The proportion of illness: 0.002% Susceptible people: women Mode of infection: non-infectious Complications: polycystic ovary syndrome premature ovarian failure
Cause
Follicular dysplasia
Premature ovarian failure (20%):
Some female follicles are not well developed due to premature ovarian failure. The patient has normal menstruation in the early stage and even has a history of birth, but then the menstruation is rare until complete amenorrhea. The follicles in the ovaries of this type of patients have been exhausted, and it is impossible to use ovulation-promoting drugs to make follicles develop, or although there are primordial follicles, No response to gonadotropins.
Polycystic ovary syndrome (28%):
Suffering from polycystic ovary is one of the reasons for poor follicular development. Polycystic ovary syndrome is the most common cause of female ovulation. Its ovary is characterized by an increase in the size of the nest and multiple small follicles, but it cannot mature. Therefore, drugs are needed to promote follicular development.
Pituitary factor (25%):
One of the causes of poor ovarian development, common diseases that cause abnormal ovulation, including pituitary prolactinoma, hyperprolactinemia, and Shi Han syndrome, high prolactin levels can inhibit ovulation.
Hypothalamic anovulation (15%):
Primary organic factors, primary functional factors, secondary organic lesions, secondary functional factors.
Prevention
Follicular dysplasia prevention
1. Maintain good working habits and try to avoid staying up late.
2. Eat less spicy or irritating food.
3. Actively participate in outdoor sports and relax.
4. Don't give yourself too much pressure and learn to decompress reasonably.
Complication
Follicular dysplasia complications Complications polycystic ovary syndrome premature ovarian failure
Follicular dysplasia can be associated with complications such as endocrine disorders and infertility.
Symptom
Follicular dysplasia Symptoms Common symptoms Estrogen deficiency Anovulatory follicle luteinization
When the follicles mature, the function will be sound, and the discharged eggs will mature and healthy. If the follicles are dysplastic, the ovulation cannot be performed normally or the quality of the discharged eggs is not good, it will affect normal fertility.
The performance of follicular dysplasia:
1, not developed: follicles are not developed, only at a very small level.
2, small follicles: follicle development, but immature, often less than 18 mm in diameter.
3, follicles are not round: development is not round, the performance is oval, and even "jujube karyotype", no fertilization ability.
4, follicles do not rupture: follicles mature, but not ruptured, unable to ovulate.
Examine
Follicular dysplasia check
Under normal circumstances, from the 8th day of the menstrual cycle, every 2 days b super monitoring once, when the diameter of the follicle is found to be 17 mm, it should be monitored once a day, when the follicular development mature diameter of 20-23 mm, If necessary, measure twice a day until ovulation.
I. Endocrine hormone test : FSH was measured, LH level was significantly higher, E2 level was significantly lower, and all reached the menopausal level. It needs to be diagnosed 3 times before it can be diagnosed. Blood PRL is normal.
Second, vaginal exfoliated cells : showing low levels of estrogen, the emergence of bottom cells or low-level cells.
Third, laparoscopic examination : ovarian premature aging can be seen small ovarian, atrophy, follicles are not obvious, no primordial follicles under the microscope, ovarian interstitial fibrosis, anti-ovarian antibodies can be found in the ovary: no response ovarian syndrome, see The ovary is normal in size, and multiple small follicles can be seen under the naked eye and under the microscope. Anti-follicular cells, anti-granulosa cells and anti-FSH antibodies can be found in the ovarian tissue.
Fourth, the development of follicular ultrasound: showed that the ovary is small, no follicles are premature ovarian failure, ovarian normal size, visible multiple follicles are non-responsive ovarian syndrome.
(1) Follicle appearance time: At the beginning of each menstrual cycle, multiple follicles develop at the same time but generally only 1 or 2 follicles develop to maturity, which is called the main follicle (preferred follicle), and the remaining follicles are successively locked. According to reports, only one follicle grows to maturity in more than 90% of the cycle, and 5%-11% has two main follicles. The earliest time of follicular ultrasound imaging can be on the 5th-7th day of the menstrual cycle, showing a minimum diameter of 4-5mm.
(2) Follicular growth rate: Ultrasound In the 3-5 days of the menstrual cycle, small follicles can be found in the ovary, and then gradually grow up, the average on the 14th day, ovulation can occur. On the fifth day of menstruation until ovulation, the main follicles increased by an average of 1.5 mm per day, an average of 1.2 mm per day before the 10th day, and an average increase of 1.9 mm four days before ovulation, until the follicles matured.
Diagnosis
Diagnosis and differentiation of follicular dysplasia
diagnosis
Mature follicles can display the following characteristics:
1. The follicle is round or elliptical, with a diameter of 15-30mm (21.2+-0.53mm). There is no echo zone in the follicle, clear and pure, the boundary is clear, and the wall is thin. 220% of mature follicles showed cumulus oophorus images one day before ovulation, showing a short strong echo in the near wall of the follicle.
2. Ultrasound images of adjacent ovulation follicles: 1 The incidence of cumulus is about 20%, mostly in >18mm mature follicles, and ovulation is predicted to occur within 24 hours. 2 The pericardial ring around the follicles, with the lh value rising, the membrane tissue edema, and the granulosa cells are separated from the membrane cells. Predicting ovulation occurs within 24 hours. The current ultrasound display rate is very low. 3 The follicular layer cells of the follicle were completely separated from the underlying layer of the membrane tissue, and the follicular wall was dentate.
